US 11,538,113 B1Granted

Methods and systems for classifying genetic panels

AssigneeCigna Intellectual Property, Inc.

InventorsJulie B. Kessel, Amanda Mills, Tommie D. Betbeze, Kathleen Luttrell

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Abstract

Methods and systems for classifying and editing insurance claims records are described. In one embodiment, a method, which can be performed by a processor, includes receiving an insurance claim record having a plurality of medical service codes, retrieving a first of a plurality of edit tables from a database, determining whether one of the plurality of medical service codes in the record matches one of a plurality of core identifier values stored in the first of the plurality of edit tables, retrieving a second of the plurality of edit tables from the database, determining whether a number of the plurality of medical service codes in the record match a plurality of confirmation values stored in the second of the plurality of edit tables, and editing the insurance claim record by including a genetic panel test medical service code in the insurance claim record.

Claims21

Dependent claims

A method comprising:

receiving, at a processor, an insurance claim record having a plurality of medical service codes;
retrieving a first of a plurality of electronic edit tables from a computerized database;
determining, at the processor, whether one of the plurality of medical service codes in the insurance claim record matches one of a plurality of core identifier values stored in the first of the plurality of electronic edit tables;
in response to determining that the one of the plurality of medical service codes in the insurance claim record matches the one of the plurality of core identifier values stored in the first of the plurality of electronic edit tables, retrieving a second of the plurality of electronic edit tables from the computerized database, the second of the plurality of electronic edit tables indicated by data associated with the one of the plurality of core identifier values determined to match the one of the plurality of medical service codes in the insurance claim record;
determining, at the processor, whether a number of the plurality of medical service codes match a plurality of confirmation values stored in the second of the plurality of electronic edit tables;
and
editing, at the processor, the insurance claim record by including a genetic panel test medical service code in the record in response to determining that at least the number of the plurality of medical service codes match the plurality of confirmation values stored in the second of the plurality of electronic edit tables.

4 more elements

A system comprising:

a computerized database configured to store a plurality of electronic edit tables;
and
a processor configured to (a) receive an insurance claim record having a plurality of medical service codes, (b) retrieve a first of the plurality of electronic edit tables from the computerized database, (c) determine whether one of the plurality of medical service codes matches one of a plurality of core identifier values stored in the first of the plurality of electronic edit tables, (d) in response to the processor determining that the one of the plurality of medical service codes in the insurance claim record matches the one of the plurality of core identifier values stored in the first of the plurality of electronic edit tables, retrieve a second of the plurality of electronic edit tables from the computerized database, the second of the plurality of electronic edit tables indicated by data associated with the one of the plurality of core identifier values determined to match the one of the plurality of medical service codes in the insurance claim record, (e) determine whether a set of the plurality of medical service codes match a plurality of confirmation values stored in the second of the plurality of electronic edit tables, and (f) edit the insurance claim record by including a genetic panel test medical service code in the insurance claim record in response to the processor determining that at least the number of the plurality of medical service codes match the plurality of confirmation values stored in the second of the plurality of electronic edit tables.

Dependencies are inferred from the claim text.